Connecticut General Statutes
Chapter 368z - Health Systems Planning Unit
Section 19a-673. (Formerly Sec. 19a-169e). - Collections by hospitals and entities owned by or affiliated with a hospital from uninsured patients.

(a) As used in this section:

(1) “Affiliated with” means (A) employed by a hospital or health system, (B) under a professional services agreement with a hospital or health system that permits such hospital or health system to bill on behalf of such entity, or (C) a clinical faculty member of a medical school, as defined in section 33-182aa, who is affiliated with a hospital or health system in a manner that permits such hospital or health system to bill on behalf of such clinical faculty member.
(2) “Collection agent” has the same meaning as provided in section 19a-509b.
(3) “Cost of providing services” means a hospital's published charges at the time of billing, multiplied by the hospital's most recent relationship of costs to charges as taken from the hospital's most recently available annual financial filing with the unit.
(4) “Hospital” has the same meaning as provided in section 19a-490.
(5) “Owned by” means owned by a hospital or health system when billed under the hospital's tax identification number.
(6) “Poverty income guidelines” means the poverty income guidelines issued from time to time by the United States Department of Health and Human Services.
(7) “Uninsured patient” means any person who is liable for one or more hospital charges whose income is at or below two hundred fifty per cent of the poverty income guidelines who (A) has applied and been denied eligibility for any medical or health care coverage provided under the Medicaid program due to failure to satisfy income or other eligibility requirements, and (B) is not eligible for coverage for hospital services under the Medicare or CHAMPUS programs, or under any Medicaid or health insurance program of any other nation, state, territory or commonwealth, or under any other governmental or privately sponsored health or accident insurance or benefit program including, but not limited to, workers' compensation and awards, settlements or judgments arising from claims, suits or proceedings involving motor vehicle accidents or alleged negligence.
(b) No hospital or entity that is owned by or affiliated with such hospital that has provided health care to an uninsured patient may collect from the uninsured patient more than the cost of providing such health care.
(c) Each collection agent engaged in collecting a debt from a patient arising from health care provided at a hospital shall provide written notice to such patient as to whether the hospital deems the patient an insured patient or uninsured patient and the reasons for such determination.
(P.A. 94-9, S. 36, 41; P.A. 95-257, S. 12, 21, 58; June 18 Sp. Sess. P.A. 97-2, S. 96, 165; P.A. 03-266, S. 5; P.A. 04-76, S. 30; 04-257, S. 39; P.A. 10-179, S. 122; P.A. 11-44, S. 133; P.A. 18-91, S. 43; P.A. 21-129, S. 1.)
History: P.A. 94-9 effective April 1, 1994; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; Sec. 19a-169e transferred to Sec. 19a-673 in 1997; June 18 Sp. Sess. P.A. 97-2 made technical changes in Subdiv. (4) of Subsec. (a), effective July 1, 1997; P.A. 03-266 amended Subsec. (a)(1) by deleting “of an uninsured patient” and changing “audited financial statements” to “annual financial filing with the Office of Health Care Access”, amended Subsec. (a)(4) by adding “who is liable for one or more hospital charges” and changing income level from 200% to 250%, and added Subsec. (c) re written notice from collection agent; P.A. 04-76 amended Subsec. (a)(4)(A) by replacing reference to “general assistance program” with reference to “state-administered general assistance program”; P.A. 04-257 made a technical change in Subsec. (c), effective June 14, 2004; P.A. 10-179 replaced “Office of Health Care Access” with “office” in Subsec. (a)(1); P.A. 11-44 amended Subsec. (a)(4) to redefine “uninsured patient” by deleting reference to state-administered general assistance program, effective July 1, 2011; P.A. 18-91 amended Subsec. (a)(1) by replacing “office” with “unit”, effective May 14, 2018; P.A. 21-129 amended Subsec. (a) by adding new Subdiv. (1) defining “affiliated with” and new Subdiv. (2) defining “collection agent”, redesignating existing Subdivs. (1) and (2) as Subdivs. (3) and (4), amending redesignated Subdiv. (4) by redefining “hospital”, adding Subdiv. (5) defining “owned by”, and redesignating existing Subdivs. (3) and (4) as Subdivs. (6) and (7), amended Subsec. (b) by adding reference to entity owned by or affiliated with a hospital and making technical changes and amended Subsec. (c) by making conforming and technical changes, effective October 1, 2022.

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